• Title/Summary/Keyword: Septic

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Diagnostic value of procalcitonin and CRP in critically ill patients admitted with suspected sepsis

  • Joen, Jae-Sik;Ji, Sung-Mi
    • Journal of Dental Anesthesia and Pain Medicine
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    • v.15 no.3
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    • pp.135-140
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    • 2015
  • Background: Identifying early markers of septic complications can aid in the diagnosis and therapeutic management of hospitalized patients. In this study, the utility of procalcitonin (PCT) vs. C-reactive protein (CRP) as early markers of sepsis was compared. Methods: A series of 2,697 consecutive blood samples was collected from hospitalized patients and serum PCT and CRP levels were measured. Patients were categorized by PCT level as follows: < 0.05 ng/ml, 0.05-0.49 ng/ml, 0.5-1.99 ng/ml, 2-9.99 ng/ml, and > 10 ng/ml. Diagnostic utility was analyzed by receiver operating characteristic (ROC) curves. Results: Mean CRP levels varied among the five PCT categories at $0.31{\pm}2.87$, $5.65{\pm}6.26$, $13.78{\pm}8.01$, $12.15{\pm}10.16$, and $17.77{\pm}10.59$, respectively (P < 0.05). PCT and CRP differed between positive and negative blood culture groups (PCT: 15.9 vs. 4.78 mg/dl;CRP: 11.5 ng/ml vs. 9.57 ng/ml;P < 0.05). The areas under the ROC curves (PCT, 95% confidence interval [CI]: 0.743, range: 0.698-0.789 at a threshold of 0.5 ng/ml; CRP, 95% CI: 0.540, range: 0.478-0.602 at a threshold of 8 mg/l) differed for PCT and CRP (P < 0.05). Conclusions: Therefore, PCT is a reliable marker for sepsis diagnosis and is more relevant than CRP in patients with a positive blood culture. These findings can be useful for the treatment of critically ill sepsis patients.

Geochemical Water Quality and Contamination of Shallow and Deep Groundwaters in Myunggok-ri, Kongju (공주시 유구읍 명곡리지역 천부 및 심부지하수의 지화학적 수질특성과 오염)

  • Jeong, Chan-Ho;Hwang, Jeong;Park, Chung-Hwa
    • Economic and Environmental Geology
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    • v.31 no.6
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    • pp.485-498
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    • 1998
  • The water-rock interaction and anthropogenic contamination affecting to geochemical composition of shallow and deep groundwaters were investigated in the agricultural area of Myunggok-ri, Kongju. The shallow groundwater is classified into the chemical types of $Ca-HCO_3$ and $Ca-Cl(SO_4)$ and shows weak acid having an average pH 6.2. Deep groundwater shows the uncontaminated composition of the chemical types of $Na-HCO_3$ and Na $(Ca)-HCO_3$ with pH of 8.4~8.8. The grouping approach of chemical data of waters shows the distinguished trend between water composition influenced anthrophogenic input and water composition mainly determined by natural process such as water-rock interaction. The main anthropogenic inputs affecting chemical composition of shallow groundwater are the contaminants such as $K^+$, $NO_3{^-}$, $Cl^-$ having average values of 4.4 mg/l, 22 mg/l, 13.7 mg/l, respectively. The contaminants were probably derived from fertilizer, sweage, septic tank, and stable, etc. The hydrogen and oxygen isotopic compositions indicate that five deep groundwaters were recharged from different altitudes, and that shallow and deep groundwaters were originated from meteoric water. Tritium contents of waters suggest that deep groundwater was recharged before or just after 1950s, and that shallow groundwater is much younger than deep groundwater. The results of this study may serve as a basic data for the future study of shallow groundwater as a drinking water in agricultural area, in Korea.

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Trichostatin A Protects Liver against Septic Injury through Inhibiting Toll-Like Receptor Signaling

  • Kim, So-Jin;Park, Jin-Sook;Lee, Do-Won;Lee, Sun-Mee
    • Biomolecules & Therapeutics
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    • v.24 no.4
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    • pp.387-394
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    • 2016
  • Sepsis, a serious clinical problem, is characterized by a systemic inflammatory response to infection and leads to organ failure. Toll-like receptor (TLR) signaling is intimately implicated in hyper-inflammatory responses and tissue injury during sepsis. Histone deacetylase (HDAC) inhibitors have been reported to exhibit anti-inflammatory properties. The aim of this study was to investigate the hepatoprotective mechanisms of trichostatin A (TSA), a HDAC inhibitor, associated with TLR signaling pathway during sepsis. The anti-inflammatory properties of TSA were assayed in lipopolysaccharide (LPS)-stimulated RAW264.7 cells. Polymicrobial sepsis was induced in mice by cecal ligation and puncture (CLP), a clinically relevant model of sepsis. The mice were intraperitoneally received TSA (1, 2 or 5 mg/kg) 30 min before CLP. The serum and liver samples were collected 6 and 24-h after CLP. TSA inhibited the increased production of tumor necrosis factor (TNF)-${\alpha}$ and interleukin (IL)-6 in LPS-stimulated RAW264.7 cells. TSA improved sepsis-induced mortality, attenuated liver injury and decreased serum TNF-${\alpha}$ and IL-6 levels. CLP increased the levels of TLR4, TLR2 and myeloid differentiation primary response protein 88 (MyD88) protein expression and association of MyD88 with TLR4 and TLR2, which were attenuated by TSA. CLP increased nuclear translocation of nuclear factor kappa B and decreased cytosolic inhibitor of kappa B ($I{\kappa}B$) protein expression, which were attenuated by TSA. Moreover, CLP decreased acetylation of $I{\kappa}B$ kinase (IKK) and increased association of IKK with $I{\kappa}B$ and TSA attenuated these alterations. Our findings suggest that TSA attenuates liver injury by inhibiting TLR-mediated inflammatory response during sepsis.

A Waterborne Outbreak and Detection of Cryptosporidium Oocysts in Drinking Water of an Older High-Rise Apartment Complex in Seoul

  • Cho, Eun-Joo;Yang, Jin-Young;Lee, Eun-Sook;Kim, Se-Chul;Cha, So-Yang;Kim, Sung-Tek;Lee, Man-Ho;Han, Sun-Hee;Park, Young-Sang
    • Parasites, Hosts and Diseases
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    • v.51 no.4
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    • pp.461-466
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    • 2013
  • From May to June 2012, a waterborne outbreak of 124 cases of cryptosporidiosis occurred in the plumbing system of an older high-rise apartment complex in Seoul, Republic of Korea. The residents of this apartment complex had symptoms of watery diarrhea and vomiting. Tap water samples in the apartment complex and its adjacent buildings were collected and tested for 57 parameters under the Korean Drinking Water Standards and for additional 11 microbiological parameters. The microbiological parameters included total colony counts, Clostridium perfringens, Enterococcus, fecal streptococcus, Salmonella, Shigella, Pseudomonas aeruginosa, Cryptosporidium oocysts, Giardia cysts, total culturable virus, and Norovirus. While the tap water samples of the adjacent buildings complied with the Korean Drinking Water Standards for all parameters, fecal bacteria and Cryptosporidium oocysts were detected in the tap water samples of the outbreak apartment complex. It turned out that the agent of the disease was Cryptosporidium parvum. The drinking water was polluted with sewage from a septic tank in the apartment complex. To remove C. parvum oocysts, we conducted physical processes of cleaning the water storage tanks, flushing the indoor pipes, and replacing old pipes with new ones. Finally we restored the clean drinking water to the apartment complex after identification of no oocysts.

Management of Traumatic Pancreas Injury in Multiple Trauma - Single Center Experience (다발성 외상 환자에서 췌장 손상 치료 경험)

  • Jang, Hyun-A;Shim, Hong-Jin;Cha, Sung-Whan;Lee, Jae-Gil
    • Journal of Trauma and Injury
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    • v.24 no.2
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    • pp.111-117
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    • 2011
  • Purposes: Pancreatic injury is rare in abdominal trauma patients (3%~12%). but it could result in significant morbidity and even mortality. Early and adequate decision making are very important in the management of patients with traumatic pancreatic injury. The purpose of this study was to assess the kinds of management and outcome through the review of our experience of pancreatic injury with multiple trauma. Methods: We reviewed 17 patients with traumatic pancreas injury via electronic medical records from Jan. 2002 and April. 2011. We collected demographic findings; the type, location and grade of pancreas injury, the treatment modality, and patient's outcomes, such as complications, length of hospital stay (LOS), and mortality. Results: Total 17 patients were reviewed, and man was 13 (88%). Traffic accident was the most common cause of injury. Pancreas neck was the most common injured site, and occured in 5 patients. Ductal injury was detected in 7 cases. Eleven patients were treated by surgical procedure, and in this group, 3 patients underwent the endoscopic retrograde pancreas drainage procedure coincidently. ERPD was tried in 8 patients, and failed in 2 patients. The major complications were post-traumatic fluid collection and abscess which accounted for 70 % of all patients. The hospital stay was 35.9 days, and it was longer in patient with ductal injury ($38.0{\pm}18.56$ vs. $34.5{\pm}33.68$ days). Only one patient was died due to septic shock associated with an uncontrolled retroperitoneal abscess. Conclusion: Early diagnosis is the most important factor to apply the adequate treatment option and to manage the traumatic pancreas injury. Aggressive treatment should be considered in patients with a post-operative abscess.

Successful Management of Feline Infectious Peritonitis with Human Recombinant Interferon-alpha and Pentoxifylline in a Cat (재조합 인간 인터페론 알파와 Pentoxifylline을 이용한 고양이 전염성 복막염의 치료 증례)

  • Kang, Min-Hee;Park, Hee-Myung
    • Journal of Veterinary Clinics
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    • v.28 no.4
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    • pp.427-430
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    • 2011
  • A 6-month-old intact female, domestic short hair cat was presented with dyspnea and anorexia for 2 days. Physical examination revealed muffled heart sound with labored breaths. Hyperproteinemia and hyperglobulinemia with polyclonal gammapathy was revealed. Pleural effusion was non-septic exudates, it also had hyperglobulinemia with decreased albumin: globuline ration. In addition, effusion RT-PCR for feline coronavirus was positive in this cat. Feline infectious peritonitis (FIP) was strongly suspected and aggressive treatments with human interferon-alpha, pentoxifylline, and glucocorticoids were initiated. The cat remained healthy without recurrence of pleural effusion during 5 months follow-up periods. To the author's knowledge, this is the first case report describing successful management of FIP with human interferon-alpha and pentoxifylline in Korea.

Medical imaging and immunohistochemical diagnosis of gastrointestinal stromal tumor originated from colon in a dog (개의 결장 간질종양에 대한 영상의학 및 면역조직화학 진단 1예)

  • Choi, Jihye;Kim, Hyunwook;Lee, Haekyung;Kim, Junyoung;Yoon, Junghee
    • Korean Journal of Veterinary Research
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    • v.48 no.1
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    • pp.111-117
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    • 2008
  • Gastrointestinal stromal tumor (GIST) is one of the mesenchymal tumors originated from gastrointestinal submucosa. A 10 year-old, male, mixed breed dog with persistent diarrhea, anorexia and lethargy was referred to Haemaru Animal Referral Hospital. Large mass originated from the transverse colon was observed and large amount of ascites and free gas were found on abdominal radiography and ultrasonography. The ascites was septic exudate mixed with bacteria that consisted with intestinal perforation. There was no metastatic lesion. This mass was tentatively diagnosed as adenocarcinoma, leiomyosarcoma (LMS) and lymphosarcoma and surgical resection and histilogical examination were planned. However, according to owner's request, the patient was euthanized and then the necropsy was performed. About 10 cm sized mass originated from the cecum, ascending colon and transverse colon was adhered to surrounding mesentery and the perforation and large amount of ascites were observed. GIST was suspected on histopathologic examination and confirmed according to CD 117 expression in immunohistochemistry. GIST, derived from interstitial cells of Cajal, can be distinguished from LMS and leiomyoma (LM) on the basis of expression of CD117 (KIT) immunohistochemically. GIST has a different biological behavior and clinical course compared with LMS and LM, therefore definite diagnosis for GIST using immunohistochemistry is clinically important to predict the precise prognosis of the patient.

Effect of municipal sludge from drainage facility on foul smell (도시내 배수설비 슬러지가 악취에 미치는 영향 연구)

  • Yu, Dae-Hyun;Park, Jihoon;Lee, Yong-Hoon;Lee, Jang-Hown;Kang, Seon-Hong
    • Journal of Korean Society of Water and Wastewater
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    • v.28 no.3
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    • pp.315-324
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    • 2014
  • The residents' odor complaint is steadily increasing by odor causing from sewage system. A current drainage facilities and septic tank are included in the individual sewerage according to Sewerage Act. However, definitions and legal standards of drainage tank are insufficient. In addition, specifications and maintenance standards related to structure and size are not established. In this research, effect of drainage tank in individual sewage facilities on the odor occurrence was studied and the concentrations of $H_2S$ and composite odor were measured. From the measurements, the concentration of $H_2S$ and composite odor were 1 ppm ~ 5 ppm and 1.04 OU ~ 4.05 OU, respectively, before pump operation. Also, the concentration of $H_2S$ and composite odor were 5 ppm ~ 33 ppm and 5.10 OU ~ 35.04 OU, respectively, after pump operation. The concentration of SS in the effluent from drainage tank was ranged from 840 mg/L to 1,980 mg/L. These high concentration of SS seemed to be the major source of foul smell when high concentrated suspended solids in the public sewerage system were decomposed and then emitted. In this research, correlation coefficient ($R^2$) between $H_2S$ and composite odor before and after pumping were 0.925 and 0.918, respectively.

Electrocautery as Adjuvant Treatment of Giant Cell Tumor (거대세포종의 보조 요법으로의 전기소작술)

  • Han, Chung-Soo;Kim, Se-Dong;Park, Sung-Hyuk;Kim, Jung-Rae;Shin, Duk-Seop
    • The Journal of the Korean bone and joint tumor society
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    • v.12 no.1
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    • pp.15-22
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    • 2006
  • Purpose: This study was designed to investigate the clinical and oncological results of giant cell tumor, treated with electrocautery as an adjuvant. Materials and Methods: We evaluated 47 giant cell tumors treated in both institution from 1989 to 2004, retrospectively. We treated all 47 cases with intralesional curettage and speed burring and followed electrocautery as an local adjuvant. Results: The mean follow up periods was 44 months and ranged from 12 to 180 months. The local recurrence occurred in 8 patients (17%) and one case lung metastasis was found. There was one case complication (septic knee) associated with electrocautery as an adjuvant. Conclusions: We thought electrocautery was feasible adjuvant treatment method of giant cell tumor, because it is very convenient technique, and the local recurrence rate was similar to any other methods.

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Effects of lipopolysaccharide and CpG-DNA on burn-induced skin injury

  • Park, Byoung-Kwon;Kim, Dong-Bum;Cho, Sun-Hee;Seo, Jae-Nam;Park, Jae-Bong;Kim, Yong-Sun;Choi, Ihn-Geun;Kwon, Hyeok-Yil;Lee, Young-Hee;Kwon, Hyung-Joo
    • BMB Reports
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    • v.44 no.4
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    • pp.273-278
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    • 2011
  • Destruction of the skin barrier by thermal injury induces microbial invasion, which can lead to the development of systemic infection and septic shock. Microbial pathogens possess pathogen-associated molecular patterns (PAMPs), which are recognized by conserved receptors. To understand the role of PAMPs in thermal injury-induced mice, LPS or CpG-DNA were topically applied to dorsal skin after thermal injury. We observed an increase in the number of inflammatory cell infiltrates as well as thickening in the dermis upon treatment with LPS or CpG-DNA. We also found that expression of IL-$1{\beta}$, MIP-2, and RANTES induced by thermal injury was enhanced by LPS or CpG-DNA. In addition, the proportions of $CD4^+$ and $CD^8+$ T cells in the spleen and lymph nodes were altered by LPS or CpG-DNA. These results provide important information concerning PAMPs-induced inflammation upon thermal injury and provide a basis for studying the role of PAMPs in thermal injury-induced complications.